儿科急诊五级预检分诊系统实践与应用现状的单中心研究

Application of the five-level pediatric emergency triage system:a single center study

目的利用儿童5级预检分诊系统分析就诊患儿相关数据,旨在提高儿科急诊工作效率及危重患儿救治率。方法回顾性观察性研究。参照国内外预检分诊系统,并根据实际情况,制订了儿科急诊5级预检分诊标准与流程。对2015年1月至2017年12月厦门大学附属第一医院儿科急诊科患儿进行研究,对患儿年龄、性别、疾病分布情况、各级患儿就诊等候时间、去向等进行分析。结果本研究共纳入375985例患儿,其中男225308例(59.9%),女150677例(40.1%)。危重、紧急患儿(I、Ⅱ、Ⅲ级)比例逐年增加,2015年为4719例(3.7%),2016年为12209例(10.2%),2017年为16188例(12.7%)。非紧急患儿中的V级患儿比例逐年下降,2015年为98213例(76.8%),2016年为75210例(62.6%),2017年为78857例(61.7%)。I、Ⅱ级患儿(1855例,0.5%)均能及时就诊;评估为Ⅲ级或Ⅳ级的患儿中有119738例(98.3%)能在规定的时间内就诊,而有2112例(1.7%)未能及时就诊。评估为Ⅲ级的患儿等待时间逐年缩短,等候时间延长率逐年下降,2015年为10.71min(延长率为2.2%),2016年为8.86min(延长率为1.5%),2017年为8.81min(延长率为1.5%)。Ⅲ级的平均等候时间为9.09min,1V级为17.7rain,V级为55.76min。危重、紧急、急诊患儿占急诊转儿童重症监护室(PICU)患儿比例增加,2015年为175例(36.2%),2016年为350例(62.8%),2017年为374例(66.2%)。疾病分布统计显示呼吸道疾病275460例(73.3%)、消化道疾病59333例(15.8%)、传染病11487例(3.1%)、神经系统疾病6230例(1.7%)。结论儿科急诊预检分诊系统制定并运行后,就诊患儿中危重症比例增加、候诊时间缩短,为早期识别危重症患儿、提高救治率及优化急诊资源起到至关重要作用。

Objective To assess the effectiveness in optimizing resources and shortening critical children's waiting time in pediatric emergency department (PED)with five-level pediatric emergency triage system (PETS).Methods This retrospective study was conducted in the First Affiliated Hospital of Xiamen University after PETS was applied.The data of patients who visited the pediatric emergency department from January 2015to December 2017were collected and analyzed,including age,sex,diseases,visiting time, triage rate and destination.Results A total of 375985patients were included,among whom males were 225308(59.9%)and females were 150677(40.1%),all younger than 14years of age.The number of critical cases (level I ,level Ⅱ and level Ⅲ)was increased from 4719(3.7%)in 2015,12209(10.2%)in 2016to 16188(12.7%)in 2017.The number of non-critical patients (level V)decreased year by year,as from 98213(76.8%)in 2015to 75210(62.6%)in 2016and 78857(61.7%)in 2017.The patients who classified as level I or level Ⅱ according to the PETS were seen immediately by physician (n=1855,0.5%).Overall, 119738patients (98.3%)who were classified as level Ⅲor level IV could be seen by physician in a timely manner according to triage guidelines,while 2112patients (1.7%)could not.The mean waiting time was 9.09min in level Ⅲ,17.7min in level IV,and 55.76min in level V patients,respectively.The critical cases admitted to the intensive care units were 175(36.2%)in 2015,350(62.80/0)in 2016and 374(66.2%) in 2017.The etiologies were respiratory diseases (73.3%),gastrointestinal diseases (15.8%)and infectious diseases (3.1%).Conclusion The application of PETS could optimize emergency resources and shorten the waiting time of critically ill children.